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What is pneumonia? What does pneumonia look like?


Joanne Fielding and Candela Iglesias

So COVID19 is all over the news. We now know that in most cases (around 81%) it causes only mild symptoms (cough, fever, etc), whereas in more severe ones, it can cause pneumonia.

In fact, it was a cluster of pneumonia cases in Wuhan, China, for which there was no known cause, that triggered the investigation leading into the discovery of the disease we now call COVID-19.

But what is pneumonia and what does it look like/feel like to have pneumonia?

Pneumonia is an inflammation of the lungs. In most cases, it is caused by an infection. The infection can be caused by viruses, bacteria or fungi. COVID-19 is caused by a virus (called SARS-CoV-2), so COVID is classified as a viral pneumonia.

Normally, when you breathe in, the air travels into your lungs and fills the air sacs in them, from where your blood gets oxygenated. When an infection of these air sacs occurs, they become inflamed and fill with fluid, secretions or pus making it difficult to breath as this blocks normal air flow and thus oxygenation. This is pneumonia.

Symptoms. Pneumonia can range in severity from mild to life-threatening. Fever can be a symptom, as well as dry or productive (mucus-producing) cough. Pneumonia can feel like tightness in the chest, especially when breathing in. It can also cause a person to breath faster than normal, in some cases even up to a point where they may only be able to speak a few words before having to take the next breath. It might feel difficult to breath and the person may feel overall fatigue.

Testing. These symptoms may be bad enough to prompt a visit to the doctor or clinic, or even, when symptoms are severe, to an emergency department. Once there, doctors would aim to diagnose if the person has pneumonia. They may request blood tests to check the markers or indicators for inflammation and infection. They may also likely request a chest x-ray to capture a picture of what is happening in the lungs and air sacs.

Depending on these results, they may aim to find the cause of the infection (remember that pneumonia can be caused by a variety of germs), and tests for specific viruses or bacteria may be requested (in the current situation, COVID-19 testing may be included).

Treatment. Antibiotics can be used for bacterial pneumonias, but for viral pneumonias - like COVID19 - antibiotics are not useful and supportive treatment is used. Supportive treatment or “symptom management” means helping the person cope better with the symptoms and be more comfortable. It includes things such as controlling fever and cough, giving fluids and rest. This helps to support the body until it manages to get rid of the infection by itself.

Depending on the results of the various tests and if general measures such as heart rate, oxygen levels and blood pressure are stable, doctors may send the person to manage pneumonia at home.

Hospitalisation. However, elderly people and/or those with preexisting conditions such as being immunocompromised, lung disease (things such as COPD or emphysema) or other long term conditions might be admitted to hospital for further monitoring. If a person’s oxygen levels were compromised due to the infection, they might also get admitted to the hospital, especially if they require oxygen through nasal prongs or a face mask.

For COVID19 pneumonia in particular, data shows the majority of COVID-19 cases at this stage of the illness recover and are able to get discharged from hospital.

However, in some cases of pneumonia whether COVID-19 or due to other causes, a person’s condition might worsen while being in hospital. They may experience increasing shortness of breath, such that they are only able to talk in single words or not at all, extreme difficulty breathing and higher oxygen needs.

Under these conditions, doctors may advise a further supportive measure called mechanical ventilation. Here, a breathing tube is inserted through a person's mouth and down towards the lungs. The tube is hooked to a machine called a ventilator, which helps the person breathe. Once the person gets better and is able to breathe again on their own, the tube is removed.

People hooked to a mechanical ventilator will normally be cared for in an intensive care unit (ICU). So far, the studies available show that only 5% or less of all hospitalised patients with COVID-19 require a mechanical ventilator.

Here you can read more about pneumonia in general (The Mayo Clinic website).

You can read more about mechanical ventilation here (American Thoracic Society)

2020-03-16 14:15:54